Perspectives: Technical considerations in performing radial procedures

Although there are many articles extolling the potential benefits of radial procedures, there are fewer reviews that deal with the ‘nitty gritty’ technical aspects needed to perform the procedures. What catheterization lab equipment is needed to convert from femoral procedures and are there technical tricks that can facilitate coronary arteriography in radial procedures? This article discusses some of these considerations. Any catheterization suite that performs femoral procedures can perform radial studies. The most important piece of equipment is a wide arm board to support the patient's arm and provide an adequate platform between the arm and the patient's body to rest the angiographer's equipment. Typically, the patient's arm is placed close to the body. Most procedures utilize the right radial artery, but the left can be used based on the patient's anatomy (particularly for tortuosity of the right subclavian artery) and the type of procedure performed, e.g. need to cannulate the left internal thoracic artery. Before either wrist is fully prepared for the radial procedure, it is critical to perform a modified Allen's test with pulse oximetry to confirm that there is adequate ulnar collateral circulation in the circumstance that the patient develops radial artery occlusion. Radial artery occlusion is a rare complication (3–6%)1 and is very well tolerated if there is adequate collateral circulation. However, if there is not adequate collateral circulation, a radial artery occlusion could lead to severe ischaemia. The modified Allen's with pulse oximetry and plethysmography is the authors' method of choice as it is more objective. The ulnar artery and its runoff directly supply the 4th and 5th digit and half of the 3rd digit. However, through collaterals it would supply blood to the first and second digit. Therefore, it is important to place the pulse oximeter on the thumb or second digit. An …